#3052 of 11K

M0101

HCPCS Procedure Code

HCPCS code M0101 is the #3,052 most-billed Medicaid procedure code, with $2.6M in payments across 36K claims from 2018–2024. The national median cost per claim is $65.66. Costs vary widely — the 90th percentile is $169.95 per claim, 2.6× the median.

Total Paid

$2.6M

0.00% of all spending

Total Claims

36K

Providers

Avg Cost/Claim

$74

National Cost Distribution

How much do providers bill per claim for M0101? Based on 83 providers billing this code nationally.

Median

$65.66

Average

$87.98

Std Dev

$88.62

Max

$708.25

Percentile Distribution (Cost per Claim)

p10

$29.28

p25

$45.86

Median

$65.66

p75

$108.87

p90

$169.95

p95

$194.90

p99

$405.85

50% of providers bill between $45.86 and $108.87 per claim for this code.

90% bill between $29.28 and $169.95.

Top 1% bill above $405.85.

About This Procedure

HCPCS code M0101 was billed by 83 providers across 36K claims, totaling $2.6M in Medicaid payments from 2018–2024. This code was used for 29K unique beneficiaries.

Risk Assessment

Billing Statistics

Median Cost/Claim

$65.66

Providers Billing

National Spending

$2.6M

Avg/Median Ratio

1.34×

Normal distribution

Top Providers Billing This Code

Ranked by total Medicaid payments for M0101

#	Provider	Total Paid	Cost/Claim	vs Median	Tier
1	Daybreak Community Services Texas Llc Fort Worth, TX · Community Based Residential Treatment Facility Intellectual and/or Developmental Disabilities	$365K	$66.77	1.0× median	Above Median
2	Berry Family Services Rowlett, TX · Case Management	$257K	$102.06	1.6× median	Above Median
3	Lifetime Living Inc. San Antonio, TX · Case Management	$123K	$339.47	5.2× median	Top 10%
4	D&s Residential Services, Lp Austin, TX · Intermediate Care Facility, Intellectual Disabilities	$119K	$58.08	0.9× median	Below Median
5	1598084774	$106K	$166.86	2.5× median	Above 75th
6	1811039225	$95K	$203.38	3.1× median	Top 10%
7	St. Giles Living Centers, Inc. Fort Worth, TX · Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	$86K	$68.67	1.0× median	Above Median
8	1326252214	$59K	$178.40	2.7× median	Top 10%
9	Wellness Healthcare Solutions Inc. Desoto, TX · Day Training, Developmentally Disabled Services	$56K	$193.31	2.9× median	Top 10%
10	1518062520	$51K	$114.38	1.7× median	Above 75th
11	1700926987	$49K	$80.08	1.2× median	Above Median
12	1871704544	$49K	$71.72	1.1× median	Above Median
13	1578551347	$48K	$103.93	1.6× median	Above Median
14	1710014618	$47K	$70.50	1.1× median	Above Median
15	1427259241	$47K	$50.17	0.8× median	Below Median
16	1912167214	$46K	$198.71	3.0× median	Top 10%
17	1619990835	$45K	$149.05	2.3× median	Above 75th
18	Kenmar Residential Hcs Services Inc. Round Rock, TX · Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	$44K	$71.63	1.1× median	Above Median
19	1891823381	$41K	$39.69	0.6× median	Below Median
20	1841409307	$40K	$97.10	1.5× median	Above Median

Showing top 20 of 83 providers billing this code

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